WHAT IS HAND ECZEMA?Eczema is an inflammation of the skin without a bacterial infection. Like eczema in general, hand eczema is therefore not contagious. Some forms can be very difficult to treat and persist for a long time. Several factors play a role in most forms of hand eczema. These factors can affect the skin from both the outside and inside.HOW DOES HAND ECZEMA DEVELOP?As mentioned, hand eczema can have several causes:
- (Prolonged) exposure to irritating and drying substances on the skin of the hands. These include fruit and vegetable juices, cleaning products, detergents, soaps, and water. Friction and low humidity (winter) also play a role. Everyone is exposed to these to a greater or lesser extent.
- Hypersensitivity to substances with which one comes into contact ( allergic contact eczema ), for example, nickel, chrome (cement), rubber, or latex (gloves). A "hypersensitivity" reaction occurs in the skin, activating the immune system. Hypersensitivity to contact substances (also called contact allergens) is demonstrated with patch tests.
- A connection with constitutional eczema . It is known that people with this eczema are more likely to develop hand eczema in adulthood, with or without contact allergy. Constitutional eczema is a specific form of eczema involving a hereditary predisposition to allergic reactions to certain substances encountered through the environment.
A specific form of hand eczema is characterized by vesicles and sometimes even blisters on the palms and/or between the fingers. This is called dyshidrotic or acrovesicular eczema . This form of eczema can result from a fungal infection on the feet or (rarely) a bacterial infection elsewhere in the body. Very often, no clear cause is found.WHAT ARE THE PHENOMENA?Hand eczema can be acute or chronic.
Acute eczema is characterized by redness, swelling, bumps, blisters, and sometimes a runny discharge. The blisters eventually dry up into scales and crusts; the skin peels and the redness subsides.
With chronic eczema, the redness is mild, scaling is more prominent, and the skin is somewhat thickened. The skin lines become coarser than normal. Cracks can develop in the rough and/or dry skin, causing pain.
Because hand eczema is usually itchy, signs of rubbing and scratching are often present in both the acute and chronic stages. Another characteristic of hand eczema is that many of the above-mentioned symptoms can occur simultaneously or consecutively.WHO IS AFFECTED BY THE DIFFERENT FORMS OF HAND ECZEMA?Hand eczema occurs primarily in people whose jobs expose them to irritants and drying substances. These professions include hairdressers, cleaners, and people working in kitchens and healthcare settings. Other occupations at increased risk include bricklayers, painters, metalworkers, floor layers, and those working in plant nurseries and trade.HOW IS THE DIAGNOSIS MADE?Hand eczema is recognized by the external characteristics of the skin condition. Determining the possible causes is often a lengthy process. In addition to extensive questions about the patient's profession, frequency of hand washing, hobbies, and the presence or absence of skin diseases or allergies in the family, further investigation into the cause is often necessary.
Using patch testing, the dermatologist can determine whether there are substances (contact allergens) to which you are hypersensitive.
The substances to be tested are applied to the back with adhesive tape and removed two days later. The test is read on that day and one or two days later. If the applied material causes an eczema reaction on the spot, you are hypersensitive to the substance in question.
Although contact allergy factors only play a role in the development of hand eczema in a minority of cases, it is important to investigate this. This allows for appropriate measures to be taken immediately.WHAT IS THE TREATMENT?In addition to local treatment of hand eczema, it's essential to follow general lifestyle guidelines. These include avoiding irritants and drying factors, regularly moisturizing your hands, and wearing gloves when in contact with water and/or irritants. Avoiding soap and water and keeping your hand skin supple is important. Substances to which you are allergic should, of course, be avoided.
Hand eczema tends to dry out the skin. Dehydration occurs due to water vapor loss as a result of degreasing. To prevent dehydration, you should keep your skin as moist as possible. Even if your skin doesn't look very dry, it's wise to moisturize it. Various basic ointments are suitable for this: a moisturizing cream (slightly moisturizing), ointment (major moisturizing), or moisturizing ointment (extra moisturizing). You can use these basic ointments as often as you like without any problems. Make sure you always have a tube with you and that you have a tube in various places around the house (bathroom, toilet).
Topical treatment for hand eczema is performed in various ways, but usually involves the use of a corticosteroid ointment or tar ointment (see also the leaflet "Corticosteroids for the skin"). Another treatment option is UV radiation.
For eczema with blisters and vesicles, regular water baths (for example, 2-3 times a day for 10-15 minutes) are also an option. However, excessive water bathing can be detrimental, as water dries out not only the blisters but also the rest of the skin.
For extensive and severe forms of hand eczema, a short course of corticosteroid tablets can quickly calm the eczema. There is also a vitamin A-derived medication for severe hand eczema, called Toctino (alitretinoin).WHAT CAN YOU STILL DO YOURSELF?It's important to treat your skin gently. Washing with soap and water is unavoidable, but do so in moderation and use skin-friendly soap whenever possible. Frequent contact with water and harsh substances (dishwashing liquids) can cause cracks in the skin. This can cause the eczema to flare up again. When washing, try to soap only the inside of your hands, if possible. Rinse your hands thoroughly and pat them dry, preferably with a dry, clean towel. When washing dishes, preferably use gloves or a dishwasher.
Rubbing and scratching can also aggravate the eczema or cause it to flare up again. Because of the itching, avoiding it isn't always easy with hand eczema.
It's wise to avoid wearing rings. This prevents irritation from substances that accumulate under the ring. Furthermore, the eczema can cause your fingers to swell, causing rings to pinch and become difficult to remove.
When cleaning or interacting with soap and water, it's wise to wear plastic (PCV) gloves with cotton liners. For dry, dirty work, wear cotton gloves. Remember that the gloves should always be clean and dry on the inside. Try not to do cleaning tasks for too long at a time, but spread them out over the day and week.
Inhospitable weather (cold, dry, and windy) can worsen the eczema. Therefore, use warm gloves and neutral ointment in a timely manner to keep the skin moisturized.
If you have a contact allergy, you should avoid all contact with the substance(s) to which you are allergic as much as possible. This is often easier said than done. If the contact allergy is work-related, adjusting your job may be the best solution.
In addition, it's important to give the eczema-affected skin as much rest as possible. Even if the skin appears normal, in most cases the skin's protective function has not yet been restored, and healing will take months. During this period, any stimulus can be enough to trigger the eczema again. Especially for young people with hand eczema, career counseling is an important form of prevention.WHAT ARE THE OUTLOOK?Hand eczema has a reputation for being persistent. Hand eczema on the back of the hand is generally less persistent than eczema on the palm. However, symptoms diminish over time or many patients experience recovery, partly because the correct examination was performed and appropriate measures were taken. If the hand eczema is occupational and changing jobs is not possible, it will have a long-term course. |
